Healthcare Provider Details

I. General information

NPI: 1477538346
Provider Name (Legal Business Name): JOSEPH VERNON KOSHIOL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 555191 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

BOX 555191 NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-8578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164445
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: